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Can I Use My Vision Insurance at UseMyFrame? How to Get Reimbursed Out-of-Network

by Neil Uher II, ABO-AC

A customer recently suggested we partner with VSP and the other vision insurance companies. It's a fair question, and one I've looked at more than once. The short answer is that we've chosen to stay independent. The more useful answer is that you can very likely still use your vision benefits with us, and in some cases come out ahead doing it.

This post covers both: why we're out-of-network, and a practical playbook for getting the most out of your plan when you order from us.

Why we stay out-of-network

When an optical business joins an insurance network, the plan sets the fee schedule, decides which frames, lenses and coatings are covered, and can restrict which labs make the glasses. Networks bring more volume, and for some businesses that's the right trade.

For us it isn't, mostly because of the lab. We make lenses here in Rock Falls on our own freeform and wrap-compensated equipment, with our own staff, and every pair is inspected before it leaves. That's how we can put new lenses in the frame you already own, turn most orders around in about a week after your frame arrives, and start single vision lenses at $49 a pair.

To be fair: if your plan fully covers lenses and you want a brand-new frame from the network's selection, in-network may be your best deal. We'd rather tell you that than pretend otherwise. The situations below are where going out-of-network with us tends to win.

Where out-of-network makes the most sense

  • You love the frame you already have. In-network benefits are built around selling you a new frame. If you only need new lenses, you pay only for lenses with us, and your plan's lens allowance goes a long way.
  • You want a second pair. Use your in-network benefit for your everyday glasses, then use HSA/FSA dollars for prescription sunglasses, computer glasses or a backup pair with us.
  • You need something plans rarely handle. Prescription dive masks, swim goggles, wrap sunglasses and smart glasses like Ray-Ban Meta usually fall outside a standard plan's covered options. An HSA or FSA can often still apply, since it's prescription eyewear.
  • You've been waiting too long. We regularly see customers who come to us while their insurance glasses are still backordered.

What the math can look like

Out-of-network benefits usually pay a fixed dollar allowance per item, not a percentage of your bill. Here's an example using real allowances from published plan summaries:

Single vision lenses in your own frame Plan A Plan B
Starting price at UseMyFrame $49 $49
Out-of-network lens allowance $25 $30
Your net cost $24 $19

That's the plan covering about 51% and 61% of the base lens price, respectively. Upgrades like progressives, coatings or photochromic lenses cost more, and allowances for those vary by plan. Your numbers will differ, but this is the calculation worth doing before you assume insurance is the cheaper route.

Five questions to ask your plan before you order

A two-minute call to the number on your ID card (or a look through your member portal) will tell you everything. Ask:

  1. "Do I have out-of-network benefits for eyeglass lenses?" Not every plan does.
  2. "What's my out-of-network allowance for my lens type?" Single vision, bifocal and progressive are usually different amounts.
  3. "Can I claim lenses by themselves, without a frame or exam?" Some plans require you to submit the exam, lenses and frame together, or treat claiming one item as using the whole benefit for the period. If you plan to use your frame or exam benefit somewhere else this year, you need to know this first.
  4. "When does my benefit reset, and what's the filing deadline?" Deadlines we've seen range from about 90 days to over a year after purchase.
  5. "Do I need pre-authorization?" A few plans, such as Superior Vision, have required a call for an authorization number before an out-of-network purchase.

Look up your benefits

Most plans let you check your out-of-network allowances and submit claims through the member site. Here are the major vision plans:

Not sure which company runs your vision benefits? It's printed on your vision ID card. Many medical insurers hand vision coverage to one of the companies above, so the name on your medical card may not match. Your employer's HR or benefits office can also tell you.

Filing your claim

  1. Place your order and pay in full.
  2. Use the itemized receipt that comes with your glasses. Every order ships with a paper itemized receipt, and you'll also have your emailed order confirmation. Plans typically want the business name, patient name, date, and each item with the amount paid, so attach the receipt to your claim.
  3. Fill out the claim form. For a lens-only order, enter UseMyFrame.com as the provider, check your lens type, put the lens amount on the lenses line, and leave the frame and exam lines blank. If the form asks for a provider NPI, ours is 1205644929.
  4. Submit online if you can. VSP and EyeMed both accept out-of-network claims through their member sites, which is usually faster than mail.
  5. Keep a copy of everything until the reimbursement arrives.

Don't let your FSA dollars expire

Prescription eyewear is generally an eligible HSA and FSA expense. Many FSAs are use-it-or-lose-it at the end of the plan year, which for a lot of people means December 31. If you have money left, a backup pair or prescription sunglasses is one of the more useful ways to spend it. Check your plan's deadline and any grace period or carryover rules with your administrator.

Not sure where to start?

Your plan's customer service line is the best source for your specific benefits, allowances and deadlines. Once you know your numbers, compare them against our pricing and pick whichever route gets you the best glasses for your money. Sometimes that's in-network, and that's okay.

And to the customer who sent the suggestion: thank you. It's exactly why I asked.

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